{*
* 2007-2011 PrestaShop
*
* NOTICE OF LICENSE
*
* This source file is subject to the Academic Free License (AFL 3.0)
* that is bundled with this package in the file LICENSE.txt.
* It is also available through the world-wide-web at this URL:
* http://opensource.org/licenses/afl-3.0.php
* If you did not receive a copy of the license and are unable to
* obtain it through the world-wide-web, please send an email
* to license@prestashop.com so we can send you a copy immediately.
*
* DISCLAIMER
*
* Do not edit or add to this file if you wish to upgrade PrestaShop to newer
* versions in the future. If you wish to customize PrestaShop for your
* needs please refer to http://www.prestashop.com for more information.
*
*  @author PrestaShop SA <payment@prestashop.com>
*  @copyright  2007-2011 PrestaShop SA
*  @version  Release: $Revision: 6594 $
*  @license    http://opensource.org/licenses/afl-3.0.php  Academic Free License (AFL 3.0)
*  International Registered Trademark & Property of PrestaShop SA
*}



    <link href="{$js_dir}jquery.validate/validate.css" rel="stylesheet" type="text/css" media="{$media}" />
    <script type="text/javascript" src="{$js_dir}jquery.validate/jquery.validate.min.js"></script>
    <script type="text/javascript" src="{$js_dir}jquery.validate/validate_payment.js"></script>
    <link href="{$js_dir}jqueryui/jquery-ui-1.8.17.custom.css" rel="stylesheet" type="text/css" media="{$media}" />
    <script type="text/javascript" src="{$js_dir}jqueryui/jquery-ui-1.8.17.custom.min.js"></script>
    <link href="{$js_dir}jqueryui/timepicker.css" rel="stylesheet" type="text/css" media="{$media}" />
    <script type="text/javascript" src="{$js_dir}jqueryui/timepicker.js"></script>
    <form action="{$request_uri|escape:'htmlall':'UTF-8'}" method="post" id="payment_frm" class="" enctype="multipart/form-data">
        <div style="background:#E2E3E4;padding:10px 10px 25px 10px;overflow:hidden;">
            {capture name=path}{l s='Payment'}{/capture}
            {include file="$tpl_dir./breadcrumb.tpl"}
            <div style="background:#fff;padding:10px;overflow:hidden;">
                <div style="padding: 0 150px; display: block;">
                    <div style="font-size: 30pt;margin:20px 0 20px 0;">
                        <img alt="" src="{$img_dir}paymenttile.png">
                    </div>
                    <ul style="float: left; list-style-type: none;">
                        <li style="float: left;margin:10px 0;">
                            <span style="float: left; margin: 0 20px 0 0; width: 100px; text-align: left;">ชื่อ <span class="input_require">*</span></span>
                            <span style="float: left; width: 430px;">
                                <input type="text" style="width:200px;" name="name" id="name" value="{$name}">
                            </span>
                        </li>
                        <li style="float: left;margin:10px 0;">
                            <span style="float: left; margin: 0 20px 0 0; width: 100px; text-align: left;">อีเมลล์ <span class="input_require">*</span></span>
                            <span style="float: left; width: 430px;">
                                {if isset($customerThread.email)}
				    <input type="text" id="email" name="email" style="width:250px;" value="{$customerThread.email}" readonly="readonly" />
				{else}
				    <input type="text" id="email" style="width:250px;" name="email" value="{$email}" />
				{/if}
                            </span>
                        </li>
                        <li style="float: left;margin:10px 0;">
                            <span style="float: left; margin: 0 20px 0 0; width: 100px; text-align: left;">เบอร์ติดต่อ <span class="input_require">*</span></span>
                            <span style="float: left; width: 430px;">
                                {if isset($customerThread.tel)}
                                    <input type="text" id="tel" style="width:200px;" name="tel" value="{$customerThread.tel|escape:'htmlall':'UTF-8'}" />
                                    <input type="hidden" name="id_contact" value="{$payment.id_contact}" />
                                {else}
                                    <input type="text" id="tel" style="width:200px;" name="tel" value="{$tel|escape:'htmlall':'UTF-8'}" />
                                    <input type="hidden" name="id_contact" value="2" />
                                {/if}
                            </span>
                        </li>
                        <li style="float: left;margin:10px 0;">
                            <span style="float: left; margin: 0 20px 0 0; width: 100px; text-align: left;">เลขที่ INVOICE <span class="input_require">*</span></span>
                            <span style="float: left; width: 430px;">
				<input type="text" id="invoice" name="invoice" style="width:200px;" />
                            </span>
                        </li>
                        <li style="float: left;margin:10px 0;">
                            <span style="float: left; margin: 0 20px 0 0; width: 100px; text-align: left;">ยอดเงินที่ชำระ <span class="input_require">*</span></span>
                            <span style="float: left; width: 430px;">
				<input type="text" id="money" name="money" style="width:200px;" />
                            </span>
                        </li>
                        <li style="float: left;margin:10px 0;">
                            <span style="float: left; margin: 0 20px 0 0; width: 100px; text-align: left;">วันที่ชำระ <span class="input_require">*</span></span>
                            <span style="float: left; width: 430px;">
				<input type="text" id="date" name="date" style="width:200px;" class="datetimepicker" />
                            </span>
                        </li>
                        <li style="float: left;margin:10px 0;">
                            <span style="float: left; margin: 0 20px 0 0; width: 100px; text-align: left;">ธนาคารที่ชำระ</span>
                            <span style="float: left; width: 430px;">
				<input type="radio" id="bank" name="bank" value="ธนาคารกสิกรไทย" checked="checked" /> ธนาคารกสิกรไทย
                            </span>
                        </li>
                        <li style="float: left;margin:10px 0;">
                            <span style="float: left; margin: 0 20px 0 0; width: 100px; text-align: left;">&nbsp;</span>
                            <span style="float: left; width: 430px;">
				<input type="radio" id="bank" name="bank" value="ธนาคารกรุงเทพ" /> ธนาคารกรุงเทพ
                            </span>
                        </li>
                        <li style="float: left;margin:10px 0;">
                            <span style="float: left; margin: 0 20px 0 0; width: 100px; text-align: left;">&nbsp;</span>
                            <span style="float: left; width: 430px;">
				<input type="radio" id="bank" name="bank" value="ธนาคารไทยพานิชย์" /> ธนาคารไทยพานิชย์
                            </span>
                        </li>
                        <li style="float: left;margin:10px 0;">
                            <span style="float: left; margin: 0 10px 0 0; width: 110px; text-align: left;">ธนาคารต้นทางที่ชำระ <span class="input_require">*</span></span>
                            <span style="float: left; width: 430px;">
				<input type="text" id="from_bank" name="from_bank" style="width:200px;" />
                            </span>
                        </li>
                        <li style="float: left;margin:10px 0;">
                            <span style="float: left; margin: 0 20px 0 0; width: 100px; text-align: left;">แนบไฟล์สลิป</span>
                            <span style="float: left; width: 430px;">
				<input type="hidden" name="MAX_FILE_SIZE" value="2000000" />
				<input type="file" style="width:200px;border:1px solid #bdc2c9;background:#ffffff;" name="fileUpload" id="fileUpload" />
				<p style="color:#799495;">(Allow File Extensions: .jpg,.gif,.jpeg,.png)</p>
                            </span>
                        </li>

                        <li style="float: left;margin:30px 0 10px 0;" _mce_style="float: left;">
                            <span style="float: left; margin: 0 20px 0 0; width: 100px; text-align: left;" _mce_style="float: left; margin: 0 20px 0 0; width: 100px; text-align: left;">&nbsp;</span>
                            <span style="float: left; width: 430px;" _mce_style="float: left; width: 430px;">เพื่อความปลอดภัย, โปรดป้อนค่า 5 หลัก&nbsp;ที่่คุณเห็นด้านล่างเพื่อเป็นการยืนยัน</span>
                        </li>
                        <li style="float: left;margin:10px 0;" _mce_style="float: left;">
                            <span style="float: left; margin: 0 20px 0 0; width: 100px; text-align: left;" _mce_style="float: left; margin: 0 20px 0 0; width: 100px; text-align: left;">&nbsp;</span>
                            <span style="float: left; width: 430px;" _mce_style="float: left; width: 430px;">
                                <input style="background:url({$img_dir}payment_captcha_bg.png); width: 97px; text-align:center; border: none; height: 21px; font-weight: bold; font-style: normal; color: #000;cursor:pointer;" class="captcha" id="captcha" name="captcha" value="{$captcha}" readonly="readonly" />
                                <input type="text" class="c_captcha" id="c_captcha" name="c_captcha" />
                            </span>
                        </li>

                        <li style="float: left;margin:20px 0 50px 0;">
                            <span style="float: left; margin: 0 20px 0 0; width: 100px; text-align: left;">&nbsp;</span>
                            <span style="float: left; width: 470px;">
                                <input type="submit" value="" style="background:url({$img_dir}paymentbtn.png); width: 163px; border: none; height: 28px; font-weight: bold; font-style: normal; cursor: pointer; color: #000;" class="submit" id="submit">
                                {if isset($confirmation)}
                                    <p>{l s='Your message has been successfully sent to our team.'}</p>
                                {elseif isset($alreadySent)}
                                    <p>{l s='Your message has already been sent.'}</p>
                                {/if}
                                <input type="hidden" name="submitMessage" id="submitMessage" value="{l s='Send'}" />
                                <input type="hidden" name="subject" id="subject" value="ยืนยันการชำระเงิน" />
                                <input type="hidden" name="message" id="message" value="{if isset($customerThread.message)}{$customerThread.message}{else}ยืนยันการชำระเงิน {$message}{/if}" />
                            </span>
                        </li>
                    </ul>
                    {include file="$tpl_dir./errors.tpl"}
                </div>
            </div>
        </div>
    </form>

